I can see health

Chapter 134 As expected of Professor Lu! (Ask for votes!)
"Dr. Fan, let me tell you my personal opinion. It is different from Dr. Min's diagnosis. I think there are two other possibilities."

What?There are two other possibilities?

As soon as Lu Chen's speech appeared in the group, it attracted the attention of everyone in the group.

They scratched their heads and couldn't even think of a diagnosis?

Now that Professor Lu is out, there are two possibilities at once?

Lu Chen's speech even attracted some melon eaters.

For example, Zhang Wulong from the People's Emergency Department of Fengma County.

He was the one who invited Fan Zhiping to join the Jinghua Electrophysiology WeChat group.

The emergency department happened to be idle for a while, and he happened to see this scene in the group while swiping his phone.

"Hey, are these two members of the Jinghua Electrophysiology Association starting the battle?"

After all, it was Professor Lu who helped him last time, Zhang Wulong still hoped that Lu Chen could win.

However, Zhang Wulong also took a look at the case just now.

He felt that Professor Min's diagnostic analysis seemed very reasonable!
What new work can Professor Lu come up with?

Everyone was looking forward to Lu Chen's next speech.

……

"Have you had an ultrasound of the patient's heart?"

As soon as Lu Chen's message appeared in the group.

Fan Zhiping picked up his mobile phone and immediately responded: "Professor Lu, the patient has just arrived in the department, and we haven't had time to do it yet. Besides, our small hospital doesn't have a bedside echocardiogram. We can only wait for the patient to get better, and let him go tomorrow or the day after tomorrow." Do."

Min Xiaobo noticed Lu Chen's speech in the group.

"Echocardiogram? What does he want to see for an echocardiogram?"

Fan Zhiping was also very curious, what other ideas did Professor Lu have?
Just now Min Xiaobo made it very clear that his reasons have convinced most people in the group, including him of course.

……

Lu Chen thought to himself: "Have you not had an echocardiogram yet? Then it's not easy to diagnose."

Before that, he carefully reviewed the two electrocardiograms sent by Fan Zhiping.

In fact, carefully observe the second ECG.

Still can find many clues.

The electrocardiogram showed extensive T wave inversions, with upright T waves in lead avR and deepest T wave inversions in leads V3 and V4.

The depression of the T wave is asymmetrical, and its vector points to the apex!

The patient's troponin is normal, and it is difficult to explain such extensive T wave inversion with only coronary ischemia!

This is also the second contradiction that Lu Chen discovered!
It is thought that after the patient was injected with Cedilan intravenously, the chest tightness worsened.

Lu Chen thought of two possibilities!

"The electrocardiogram has ST-segment reverse elevation and depression, which is considered to be caused by myocardial hypertrophy. If the patient is hypertrophic obstructive cardiomyopathy, after Cedilan strengthens the heart, the obstruction of the ventricular outflow tract will be aggravated, and the cardiac output will be reduced. , And then lead to insufficient perfusion of the brain, coronary arteries, etc., manifested as chest pain, chest tightness, and dyspnea, that is, the symptoms of heart failure are aggravated!"

When Min Xiaobo saw Lu Chen's speech in the group, his eyes suddenly lit up.

Yup!

This electrocardiogram does have the possibility of hypertrophic obstructive cardiomyopathy.

For patients with hypertrophic obstructive cardiomyopathy, after using Cedilan, the symptoms of chest tightness and chest pain will aggravate!
This is equivalent to a blocked water pipe, and you have to increase the horsepower and give it more pressure.

This not only can't get out of the water, but also may damage the water pipe.

As long as they are cardiologists, they almost all know that when patients have hypertrophic obstructive cardiomyopathy, Cedilan is contraindicated.

However, when patients use Cedilan and experience chest tightness symptoms, few people would think that this is hypertrophic obstructive cardiomyopathy!

No wonder Lu Chen asked the patient if he had an echocardiogram.

Hypertrophic obstructive cardiomyopathy is usually diagnosed by ultrasound, which cannot be seen on chest CT.

Min Xiaobo was a little annoyed, why didn't he think of such a simple knowledge point?

People from other departments in the group may not be able to understand this feeling, but as long as they are from the cardiology department, their mood at this time is somewhat similar to that of Min Xiaobo.

A question that is obviously very simple, but I racked my brains and couldn't think of it.

Then after being instructed by others, it suddenly dawned on me!
This feeling, with a bit of annoyance, but also with a tinge of joy.

……

Zhang Wulong in the emergency department was a little puzzled, he didn't quite understand the professional knowledge in his heart.

But after Lu Chen finished speaking, no one responded in the group for a long time.

Did Professor Lu stumble?

At this moment, Fan Zhiping spoke again.

"Professor Lu, this is the first possibility. Didn't you say there is a second possibility?"

In fact, when he saw the words hypertrophic obstructive cardiomyopathy, he knew that Lu Chen was probably right!

He is the receiving doctor of this patient, and he has the most intuitive feeling.

According to the patient's symptoms, signs and auxiliary examination results, the probability of hypertrophic obstructive cardiomyopathy is very high!

But as soon as this thought came to his mind, he thought of what Lu Chen said.

There are two possible diagnoses!

Fan Zhiping had just confirmed the diagnosis of hypertrophic obstructive cardiomyopathy, but now he has wavered again.

All because of what Lu Chen said, there are two possibilities!
The group was very quiet, everyone was waiting for Lu Chen's next possibility.

Min Xiaobo sat in the duty room with an extremely serious expression. He was also looking forward to Lu Chen's next speech.

Hypertrophic obstructive cardiomyopathy was unexpected to him, but he was not very convinced.

This point of knowledge is very simple, but it was ignored by him.

He wants to see, what convincing diagnosis will this Lu Chen, who is also an elite member of the Jinghua Electrophysiological Association, come up with? !
……

Eight districts in the heart.

When it was time to get off work, Yue stood up and stretched.

Jiang Qingyan has been going to the skill center for training recently, and she doesn't really want to go to the cafeteria to eat alone.

"Lu Chen, let's have lunch together."

"Oh, I still have something to do, why don't you go first and don't wait for me."

Lu Chen held the phone and edited the information without looking up.

This passage is relatively long.

Lu Chen checked it once and sent it out without any typos.

"The second possibility is stress cardiomyopathy. The cause may be chronic obstructive pulmonary disease, because chronic obstructive pulmonary disease itself is hypoxia, which can easily lead to rapid heart rate, sympathetic excitement, and easy release of large amounts of catecholamines, especially after menopause Elderly women are more likely to develop stress cardiomyopathy on this basis!"

"Cedilan is similar to catecholamines (dopamine, epinephrine, norepinephrine), after use, it will aggravate the condition! Secondly, the base of stress cardiomyopathy is hyperkinesia, the contraction force of the apex is weakened, and the hypertrophy of the outflow tract obstruction Cardiomyopathy is quite similar."

"In my opinion, do echocardiography first to rule out hypertrophic obstructive cardiomyopathy; if not, do coronary angiography to determine whether there is stress cardiomyopathy."

If we say, Min Xiaobo might not be too convinced about the first possibility Lu Chen mentioned.

When Lu Chen mentioned stress cardiomyopathy, he first showed doubts, then was shocked, and finally just shook his head helplessly.

Combined with this case, the diagnosis of stress cardiomyopathy is well-founded and convincing!
Why, he wouldn't think of the diagnosis of stress cardiomyopathy!

"Who is he?"

Min Xiaobo had to re-examine this elite member named Lu Chen.

……

After Lu Chen finished speaking in the group.

The wechat group exploded.

No one expected stress cardiomyopathy.

But after listening to Lu Chen's analysis, everyone thought it made sense!

The disease cannot be diagnosed, but it does not hinder the ability to judge the disease.

"Professor Lu's analysis is too good!"

"I'm also in the cardiology department! Although I know all the diseases that Professor Lu said, I just can't think of it!"

"Dr. Fan, wait for the patient's symptoms to recover, and push the patient for an examination! I'm really looking forward to the patient's final diagnosis!"

This group of people are really ignorant!
Fan Zhiping had to sigh.

"As expected of Professor Lu!"

　Make up for the second update owed yesterday, and also owe the first update yesterday.

　　In addition, there are 2 updates today, 1700+ recommended votes, and a chapter will be added to the recommended votes.

　　The monthly ticket is 300+, which is not enough for the time being.

　　So I still owe 4 updates, and I will try my best to pay it off tonight!
　　
　
(End of this chapter)